GPPO3: The Impact of Enhanced Recovery Protocol (ERAS) In Peritoneal Surface Malignancies Managed with Cytoreductive Surgery & Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Multicentric Collaboration
Senior Consultant National Cancer Institute, Cairo University- Ministry of National Guard Health Affairs-MNGHA-Eastern Province -KSA Cairo, Egypt
Background: CRS &HIPEC is an increasingly utilized effective approach for PSM which are associated with a dismal prognosis when treated with palliative chemotherapy. Proper patient selection to undergo CRS & HIPEC through a multidisciplinary team and the implementation of ERAS protocols are mandatory for improved outcomes.
Methods: This is a retrospective study comparing the short term surgical and preliminary oncological outcomes in patients undergoing CRS & HIPEC for PSM in the pre (1014-2016) and post (2017-2021) ERAS protocol implementation in 4 tertiary centres in Egypt, USA and KSA.
Results: 130 females & 20 males were enrolled; 75 patients were equally distributed in the Pre & ERAS periods. Disease sites were; ovarian (110), colorectal (18), appendiceal (15) and Gastric Cancer (7). The mean age was 53.1 years, PCI had a mean of 16.8 ( <16 in 48.3%, 16-20 in 44.6% and more than 20 in 7.1%). Regarding Completeness of Cytoreduction, CC0 was achieved in 77%, CC1 in 20 % and CC2 in 3%. On comparing the Pre-ERAS /ERAS Era, the mean total Intravenous fluid use was 30.5 &17.1 Litres (P <0.003), whereas the mean hospital stay was 10.2 & 8.3 days respectively (P <0.001). The average operative time was 11.30 hours. Postoperative 30-day morbidity was 48.3% with no mortality. The 2 years DFS was 55.9% & the 2 years overall survival was 78%.
Conclusion: Management of PSM is feasible in limited resource settings. It should be performed in highly specialized centres with well-trained teams, and proper patient selection through a MDT. The ERAS Protocol has resulted in significant decrease in hospital stay and Intravenous fluids.